The long-term objectives of Dr. Susan Mitchell's career as a geriatrician and clinical investigator are to conduct patient-oriented research (POR) and provide mentoring to beginning investigators to improve the health care of older persons. Dr. Mitchell is at an optimal point in her career for a K24 award. Over the past 13 years, she has established a clinically and policy relevant research program focusing on the outcomes, decision-making, and health care utilization of older persons with advanced dementia. She has an outstanding track record of independent funding and high impact publications. Dr. Mitchell's currently funded work in advanced dementia provides an excellent teaching platform for her mentees and is a source of new scientific direction for her own research. Dr. Mitchell has established herself as a successful mentor of trainees at all levels and from both within and outside geriatrics. Her mentoring activities have steadily grown over the past 7 years. Dr. Mitchell leadership roles focus exclusively on research training for beginning investigators. Attainment of her objectives is facilitated by the superb research infrastructures and training programs at the Institute for Aging Research at Hebrew Senior Life, Harvard, and the Beth Israel Deaconess Medical Center, which attract high caliber trainees in geriatric medicine and cross-cutting disciplines, and provide optimal settings to promote their success. The specific aims of this five year K24 award application are to: 1. Perform rigorous POR aimed at improving the end-of-life experience of persons with advanced dementia and their families and;2. Use this research as a platform to mentor new investigators in aging- related POR, and help them to become independent investigators. Aim 1 will be accomplished through two currently funded and two future studies. On-going studies include: i. A large prospective cohort study of nursing home residents with advanced dementia and their families and, ii. The derivation and prospective validation of a mortality risk score for advanced dementia. The two future projects will focus on utilization, decision-making, and outcomes of antimicrobial use in advanced dementia. Aim 2 will be accomplished by: i. Structured, individual mentorship of young investigators with strong interests in POR and palliative care for older persons, from all training levels and various fields, including geriatrics as well as other disciplines, ii. Recruitment of high caliber mentees from research training programs and academic centers, iii. Consolidating and deepening Dr. Mitchell's leadership activities in research training, iv. Didactic sessions and formal coursework for mentees, and v. Further development of Dr. Mitchell's mentorship skills. RELEVANCE: With this award, Dr. Susan Mitchell will further develop her research program aimed at improving the end-of- life experience of persons with advanced dementia and their families. She will use her research as a platform to mentor new investigators in this field, and help them to become independent investigators. Thus, by promoting Dr. Mitchell's research and her mentorship new trainees, this award will ultimately benefit the increasing number of elderly people with dementia who seek palliative care near the end-of-life.